Divorce Intake Form Please provide your details so we can assist with your Divorce application Title Mr. Mrs. Ms. Mx. Dr. Miss Hon. Rev. Rabbi Rep. Sen. Master Sir Lady Hon mr MR ms MS Your first name Your middle name Your last name Your preferred first name Your date of birth Country of Birth If you were not born in Australia, what date did you start living in Australia? Your email address Your occupation Contact type Business Home Mobile Direct Dial Home Fax Assistant Business 2 Home 2 Mobile 2 Other Phone number Contact type Business Home Mobile Direct Dial Home Fax Assistant Business 2 Home 2 Mobile 2 Other Phone number Your address Your address continued Suburb Post code State Country Approximate cohabitation date Date of marriage Place of Marriage Do you have a Marriage Certificate? Yes No Exact Names on Marriage Certificate (please include middle names) Approximate separation date Date of divorce (if applicable) Children's names (including middle names) Children's DOB If you have Children under 18 years, please provide details about how much time is spent with each parent If you have Children under 18 years, what financial support is provided for the Child(ren) If you have Children under 18 years, what School and Year is the Child(ren) in? If you have Children under 18 years, where do they live? Other side first name Other side last name Other side date of birth Other side email address Other side occupation Other side contact type Business Home Mobile Direct Dial Home Fax Assistant Business 2 Home 2 Mobile 2 Other Other side phone number Other side address Other side address continued Other side post code Other side suburb Other side state Other side country Solicitor firm for the other side (if known) Solicitor contact name Solicitor email address Solicitor contact type Business Home Mobile Direct Dial Home Fax Assistant Business 2 Home 2 Mobile 2 Other Solicitor phone number Solicitor address Solicitor address continued Solicitor suburb Solicitor state Solicitor post code
